Akinosoglou Karolina, Schinas Georgios, Polyzou Eleni, Tsiakalos Aristotelis, Donders Gilbert G G
Department of Medicine, University of Patras, 26504 Rio, Greece.
Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece.
J Clin Med. 2024 Aug 30;13(17):5163. doi: 10.3390/jcm13175163.
Vulvovaginal candidosis (VVC) represents a frequent and cumbersome vaginal infection. Recurrent and/or persistent infections remain common among a significant number of patients despite the use of antifungals. Probiotics offer a promising adjunctive or alternative therapeutic strategy to antifungals in the management of VVC. We aimed to explore and thoroughly examine the various roles and potential applications of probiotics in VVC. A comprehensive literature search was conducted to identify relevant clinical trials and systematic reviews that examine the effectiveness of probiotics in the treatment and prevention of VVC and recurrent VVC (rVVC). Following the initial screening of 4563 articles, a total of 25 clinical studies and seven systematic reviews were finally included in this analysis. The studies reviewed provide a generally positive yet inconsistent view of the efficacy of probiotics in managing VVC, including clinical, mycological response, and prevention perspectives. Nonetheless, fluconazole remains more effective than probiotics in treating VVC, while the combination of the two seems to reduce recurrence and improve symptoms significantly. For prevention, probiotics seem to improve vaginal health and reduce symptoms, while safety and tolerability are consistently reported across the studies, affirming that probiotics represent a low-risk intervention. However, clear conclusions are difficult to establish since relative studies explore different clinical endpoints and follow-up times, variable populations are included, different probiotics are used, and diverse schedules and regimens are administered. We propose that future studies should study the benefit of probiotics in well-defined categories such as (1) treatment with acute probiotics instead of antifungals, (2) adjuvant probiotic therapy together or after antifungals, and (3) VVC recurrence prevention using probiotics.
外阴阴道念珠菌病（VVC）是一种常见且棘手的阴道感染。尽管使用了抗真菌药物，但复发性和/或持续性感染在大量患者中仍然很常见。益生菌为VVC的管理提供了一种有前景的辅助或替代抗真菌治疗策略。我们旨在探索并全面研究益生菌在VVC中的各种作用和潜在应用。进行了全面的文献检索，以识别相关的临床试验和系统评价，这些研究考察了益生菌在治疗和预防VVC及复发性VVC（rVVC）方面的有效性。在初步筛选4563篇文章后，本分析最终纳入了25项临床研究和7项系统评价。所综述的研究对益生菌在管理VVC方面的疗效给出了总体积极但不一致的观点，包括临床、真菌学反应和预防方面。尽管如此，氟康唑在治疗VVC方面仍然比益生菌更有效，而两者联合使用似乎能显著降低复发率并改善症状。对于预防，益生菌似乎能改善阴道健康并减轻症状，同时各项研究一致报告其安全性和耐受性良好，这表明益生菌是一种低风险干预措施。然而，由于相关研究探索的临床终点和随访时间不同，纳入的人群各异，使用的益生菌不同，以及给药方案和疗程多样，因此难以得出明确结论。我们建议未来的研究应在明确界定的类别中研究益生菌的益处，例如（1）使用急性益生菌而非抗真菌药物进行治疗，（2）在使用抗真菌药物的同时或之后进行辅助益生菌治疗，以及（3）使用益生菌预防VVC复发。
